What is Open-Mindendess?

When discussing the evidence for and against CAM, especially with passionate believers, the issue of “open-mindedness” almost always comes up. Despite my desire to be insightful and original, I can think of no better beginning for discussing this idea than the old cliché: Always keep an open mind–but not so open that your brain falls out!

Science is dedicated to the principle of letting the facts have the final word, and so pre-judging an idea is contrary to the core philosophy of science. Any idea should stand or fall on its merits, not merely one’s feelings or a priori biases. So when I encounter a new CAM therapy, or even new evidence regarding one I am already familiar with, I approach it with an open mind. This means that even if my intuition tells me the idea is nonsense, I ask questions about the principles and I ask for evidence, for data to support that it does what the person claims it does. If this evidence is high quality (meaning well-conducted scientific research, preferably replicated randomized placebo-controlled clinical trials), then I’m on board! If the evidence is suggestive but not definitive (a plausible rationale, supportive in vitro research, perhaps some case reports), then I reserve judgment pending further study. But if the evidence is of poor quality (individual testimonials, no matter how many, proprietary research by an organization selling the product, underlying principles that violate well-established laws of nature, appeals to authority or tradition, and so on), then it moves me not!

The fundamental misunderstanding many people have about “open-mindedness” is that it means either not judging something to be true or false at all, or applying no standard of quality to the evidence used to judge the verity of a proposition. I was recently read the riot act by another doctor at my practice for being rigid and closed-minded about alternative therapies. When questioned, it turned out that what she meant was that believing scientific research is superior to anecdote, personal impressions, and cultural traditions as a form of evidence is to be closed-minded. Unfortunately, this is an example of a dangerous misunderstanding that even an extensive education in medical science does not apparently protect one against.

The history of medicine offers countless examples of why many smart people over many generations can be wrong about whether a therapy works or doesn’t work. Bloodletting, cupping, and purging are excellent examples of therapies which persisted for centuries with widespread belief in their efficacy among medical professionals and the general public but which we now know are not beneficial, and can even be harmful. The unprecedented increase in the length and quality of life for most human beings since the advent of scientific medicine is further evidence that clinical judgment and tradition are inferior to properly-conducted research in determining the validity of medical interventions. Science deserves to be taken more seriously than intuition or tradition not based on some patriarchal, ethnocentric, narrative of hegemony (as the post-modernists would have it) but because it has demonstrated its epistemological superiority in the real world, and has changed fundamentally the nature of the human experience.

Why, exactly, we trust our judgment far more than it deserves is a complex and fascinating topic. I have listed below a number of books which investigate this question, and which I have found profoundly eye(and mind)-opening. It is clear that our perceptions are heuristic, quick and dirty methods for making fast and efficient judgments that worked more often than not in the evolutionary environment that shaped our brains. But in the far more complex and ambiguous world of modern medicine, we can do better. We can do science!

The accusation of closed-mindedness leveled so often at skeptics of CAM usually carries the implication of intellectual arrogance as well. This strikes me as wonderfully ironic. To say that I as an individual, no matter how smart and well-educated and experienced, can be led astray by cognitive errors that are intrinsic to the structure and operation of my brain and so that I must rely on the processes of science above my personal feelings and judgment is arrogant. However, to assert that my personal experiences “prove” the truth of something so thoroughly that any contradictory scientific research can be dismissed is to be “open-minded.” Clearly, this makes no sense. It is a weak post hoc rationale for doing what we desperately want to do—believe we are right because we feel like we’re right.

So open-mindedness, properly understood, means judging each idea on its own merits, not on where it comes from, what other ideas it resembles, or how brilliant or foolish it makes us feel. It means getting as close to an objective, dispassionate understanding of the facts as we can and then basing our conclusions on those facts, not on our intuition or gut feelings. In short, it does not mean we should not try to judge if something is true or not but that we should base these judgments on the kind of evidence that has proven reliable before. And this means scientific evidence, not anecdote or tradition or faith.

Further Reading

Don’t Believe Everything You Think: The 6 Basic Mistakes We Make in Thinking

By Thomas Kida

On Being Certain: Believing You Are Right Even When You’re Not

By Robert Burton

How We Decide

By Jonah Lehrer

Mistakes Were Made (But Not by Me): Why We Justify Foolish Beliefs, Bad Decisions, and Hurtful Acts